Compensation based on work relative value unit for cardiovascular surgeons in Iran: A mixed method study

Sara Forootan; Saeed Danaei; Sakineh Hajebrahimi; Behzad Najafi; Mohammad Asghari-Jafarabadi; Ali Janati

doi:10.4103/jehp.jehp_1381_22

Compensation based on work relative value unit for cardiovascular surgeons in Iran: A mixed method study

J Educ Health Promot. 2023 Oct 31:12:354. doi: 10.4103/jehp.jehp_1381_22. eCollection 2023.

Authors

Sara Forootan¹, Saeed Danaei², Sakineh Hajebrahimi³, Behzad Najafi⁴, Mohammad Asghari-Jafarabadi^{5

6

7}, Ali Janati⁸

Affiliations

¹ Health Policy and Management Department, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
² Cardiovascular Research Center, Shahid Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
³ Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
⁴ Department of Health Economics, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
⁵ Cabrini Research, Cabrini Health, Melbourne, VIC, 3144, Australia.
⁶ School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3800, Australia.
⁷ Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
⁸ Iranian Center of Excellence in Health Management, Health Policy and Management Department, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: Work relative value unit (wRVU) is a tool for assessing surgeons' performance, compensation, and productivity. It appears that wRVU for cardiovascular procedures does not consider complexity and its value for lengthy operations is low. The aim of the study is to determine wRVU for cardiovascular procedures in Iran according to the proposed approach.

Matterials and methods: This study was conducted as a mixed method in teaching hospitals in Tabriz in the period of September 2020 to December 2021. According to Hospital Information System and expert opinions, six procedures in cardiovascular surgery were included in the study. They were compared with 18 procedures in neurosurgery, orthopedics, and otorhinolaryngology in terms of the operation time and wRVU/min. Then, we calculated new wRVUs for the selected procedures based on surgeons' opinions, time measurements, and anesthetists' points of view by content analysis in qualitative and statistical analysis in quantitative parts.

Results: Among the six cardiac procedures, the wRVU for five was under-estimated. The wRVU/min value ranged from 0/28 to 1/15 in the studied procedures. Findings demonstrate no significant relationship between the length of operations and the wRVU announced by the Ministry of Health and Medical Education (P value >0/05). Compared to studied procedures in four specialties, thoracoabdominal aortic aneurysm repair has the longest surgery time at 417 minutes. According to anesthesiologists, cardiovascular; orthopedics; ear, nose, and tongue; and neurosurgery specialties obtained 4/2, 2/9, 2/8, and 4, respectively, in terms of surgery duration, complexity, risk, and physical effort.

Conclusion: Despite policymakers' attempts to bring justice to payments, it seems that there has been little progress in paying cardiovascular surgeons. Improper payment to cardiovascular surgeons will affect the future of the workforce in this specialty. Today, the need to reconsider the wRVUs in heart specialty is felt more than before.

Keywords: Cardiovascular surgical procedures; compensation; relative value scales; surgeons.